Term
| What is Acute Lung Injury? |
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Definition
| It is a systematic process of pulmonary organ dyfunction that is characterized by NONCARDIAC PULMONARY EDEMA adn disruption of the alveolar-capillary membrane as a result of injury to either the pulmonary vasculature or the airways. |
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Term
| What is the defining criteria of ALI? |
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Definition
| Acute in onset, PaO2:FiO2 ratio is < or = to 300mm Hg (regardless of PEEP), Bilateral lung infiltrates on x-ray, and PAOP < or = 18mm Hg with no evidence of LA HTN. |
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Term
| What are the risk factors for direct ALI? |
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Definition
| Aspiration, Near-drowning, Toxic Inhalation, Pulmonary contusion, Pneumonia, Oxygen Toxicity, and Transthoracic irradiation. |
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Term
| What are the risk factors for indirect ALI? |
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Definition
| Sepsis; Nonthoracic trauma; Hypertransfusion; Cardiopulmonary bypass; Severe pancreatitis; Embolism - air, fat, amniotic, fluid; DIC, and Shock states |
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Term
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Definition
| The lung epithelium sustains a direct insult |
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Term
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Definition
| Insult occurs elsewhere in the body and mediators are carried to the lungs |
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Term
| What are the 3 phases of ALI? |
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Definition
| Exudative, Fibroproliferative, and Resolution |
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Term
| The exudative phase occurs within __ hours of insult. |
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Definition
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Term
| What happens during the exudative phase? |
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Definition
| Immune responses causes fluid to build up in the alveoli causing damage to the alveoli epithelium leading to a collapse of the alveoli, which causes hypoxemia to occur. |
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Term
| During the exudative phase, there is __ airway resistance, __ lung compliance, causing __ work of breathing. |
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Definition
| Increased, Decreased, Increased |
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Term
| Increased work of breathing in the exudative phase leads to ____. |
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Definition
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Term
| What happens the the Right ventricle when pulmonary hypertension occurs during the exudative phase? |
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Definition
| RV afterload increases leading to RV dyfunction and decrease in CO. |
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Term
| What happens during the fibroproliferative phase of ALI? |
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Definition
| Lung begins to heal and becomes fibrotic. Scarring of the capillaries occurs. Hypoxemia, pulmonary HTN, and stiffening of the lungs continue to increase. |
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Term
| What happens during the Resolution phase of ALI? |
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Definition
| Structural and vascular remodeling takes place and the alveolar-capillary membrane is eventually re-established. This takes several weeks. |
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Term
| What s/s are seen in the exudative phase of ALI? |
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Definition
| Tachypnea, Restlessness, Apprehension, Increased use of accessory muscles. |
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Term
| What s/s are seen during the fibroproliferative phase of ALI? |
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Definition
| Agitation, Dyspnea, Crackles in lungs, excessive use of accessory muscles, and fatigue. |
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Term
| What does the ABG reveal in a patient with ALI? |
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Definition
| Low PaO2, PaCO2 is initially low, then becomes elevated, pH is initially elevated, then becomes low as acidosis develops. |
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Term
| What will a Chest X-Ray show in a patient with ALI? |
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Definition
| It may be normal initially. As pulmonary edema develops - diffuse, patchy interstitial and alveolar infilitrates, progresses to "whiteout" as consolidation occurs. |
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Term
| What are the goals of medical management with ALI? |
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Definition
1. Treat Underlying Cause
2. Promote gas exchange (ventilator, O2)
3. Support tissue oxygenation
4. Prevent Complications |
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Term
| How are complications prevented through mechanical ventilation? |
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Definition
| Keep Tidal Volume low (6-10ml/kg), use permissive hypercapnia, use pressure control ventilation, and inverse ratio ventilation (allows gas exchange across damaged membrane) |
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Term
| What is the goal of O2 therapy in patients with ALI? |
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Definition
| Maintain arterial Hgb oxygen saturation of 90% or greater using the lowest level of O2. Keep PEEP between 10-15cm H2O (need alot of pressure to push O2 across membrane). |
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Term
| How is tissue perfusion maintained in ALI? |
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Definition
| Maintain a low intravascular volume so tissue is not further damaged. Wedge pressure (PAOP) of 5-8(low), an support CO with vasoactive adn inotropic meds (Dopamine, Dobutamie, etc.) |
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Term
| What are 3 top nursing diagnoses for ALI? |
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Definition
| Impaired Gas Exchange, Decreased Cardiac Output, and Imbalanced nutrition: less than body requirements |
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Term
| What are the best ways to optimize ventilation and oxygention in a patient with ALI? |
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Definition
| Prone positioning or "good lung down", prevent desaturation, promote secretion clearance, and monitor vent settings and alarms. Monitor ABGs. |
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Term
| What are other Nursing interventions for patients with ALI? |
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Definition
| Provide comfort and emotional support, provide and monitor nutritional intake, and monitor for complications. |
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Term
| What are some complications associated with ALI? |
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Definition
| Cardiac Dysrhythmias (not enough O2 to the myocardium causing dysrythmias; VTE (Venous thrombo-embolism), and GI bleeding. |
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